Oral Precancerous Lesions Flashcards
85% of oral precancers are?
Leukoplakias
A simple definition of leukoplakia is?
Suspicious white patch
What are 4 factors in the development of leukoplakia?
Tobacco smoking, sanguinara, UV, microorganisms
Who typically gets leukoplakia?
Men over 40
Where do most leukoplakia occur?
Lip vermilion, buccal mucosa, gingiva
Is leukoplakia a microscopic diagnosis?
No just a clinical impression
Describe a mild/thin leukoplakia
Grey-white with sharply defined borders, soft, slightly elevated
Which variant of leukoplakia has the highest risk of malignancy?
Erythroleukoplakia, a white plaque with scattered red patches
Most leukoplakias exhibiting dysplasia or carcinoma are in what locations?
Tongue, lip vermilion, floor of mouth
Most cases of leukoplakias are what microscopically?
Benign hyperkeratosis
What percentage of leukoplakias become SCC? What percentage are malignant initially?
4 and 5% respectively
What percentage of dysplastic leukoplakias become malignant?
10-15%
Which gender has a higher risk of malignant transformation?
Female
How is malignant transformation typically predicted?
Histopathologic grading of dysplasia
What 3 markers indicate a possible evolution to cancer?
p16, p53, and ki-67
What does the term sublingual keratosis refer to?
Leukoplakias on the ventral surface of the tongue, floor of mouth, and lingual aspect of the mandibular alveolar mucosa. These have a high risk for dysplasia and carcinoma
A high risk form of leukoplakia with multiple white plaques and roughened surface projections is?
Proliferative verrucous leukoplakia
Most cases of proliferative verrucous leukoplakia occur in ?
Elderly women with no risk factors
How does erythroplakia compare to leukoplakia in terms of frequency and risk of malignancy?
Less common but more likely to be malignant
Erythroplakia presents as?
A red patch that cannot be classified as any other condition
In the US, most cases of erythroplakia are seen in?
Elderly men
Where are most cases of erythroplakia seen?
Floor of mouth, tongue, retromollar-tonsillar pillar, soft palate complex
How do most cases of erythroplakia appear microscopically?
90% are malignant or dysplastic
The epithelium in erythroplakia can be described as?
Non-keratinized and atrophic
Reverse smoking is associated with?
Dysplasias and cancers of the palate
The dysplasias of the palate seen in reverse smoking are called?
Nicotine palatinus
What changes in the mucosa are seen with use of smokeless tobacco?
Rippled, faintly white mucosa
How long does it take for smokeless tobacco keratosis to reverse?
6 weeks
What type of smokeless tobacco carries the greatest risk of oral cancer?
Dry snuff
Keratosis associated with betel chewing is strongly or weakly associated with dysplasia and SCC?
Strongly
Where is betel quid used?
South Asia
What are two consequences of betel quid use?
Submucous fibrosis and epithelial dysplasia/carcinoma
Can betel quid without tobacco be carcinogenic?
Yes
Submucous fibrosis typically affects who?
Young and middle aged adults
The progressive mucosal stiffening in submucous fibrosis leads to?
Marblelike pallor that progresses to trismus
What tissues are seen in sub mucous fibrosis?
Very dense collagenous fibrous connective tissue with chronic inflammation
What epithelial changes are seen in dysplasia associated with betel chewing?
Sub epithelial vesicles in early lesions
Hyperkeratosis with marked atrophy in older lesions
How much does oral sub mucous fibrosis increase the risk of getting oral cancer?
19x
What is betel chewers’ mucosa
A benign change in which the mucosa becomes brown/red
What is actinic cheilosis
A pre malignancy of the lower vermilion due to UV
Who typically gets actinic cheiolosis
Fair skinned elderly men
What are the first clinical signs of actinic cheilosis?
Atrophy of the lower lip vermilion with smooth surface and blotchy pale areas
The epithelium in actinic cheilosis can be described as?
Atrophic with heavy keratin
